Implementing IHE inside the Enterprise Care Settings World of Health IT October 11, 2006 12:1513:00

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Implementing IHE insidethe Enterprise Care
SettingsWorld of Health ITOctober 11, 2006
1215-1300

• Harm-Jan Wesselsmanaging director,
  Forcarevendor co-chair, IHE-Netherlands

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Objective of this Presentation

• To provide an overview of how IHE integration
  profiles are applied across the care settings
  within an Enterprise
• To show the analogies across the domains
• To provide a structured approach to finding the
  right IHE integration profiles to use

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Topics

• General IHE Introduction
• Overview of the IHE domains
• The building blocks
• Radiology
• Translating/Mapping to other care domains
• IHE implementations
• Guidance on using IHE
• Questions / Answers

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Short Introduction

• My name Harm-Jan Wessels
• Active in Healthcare IT since 1990
• Applicare Medical Imaging (90-99)
• Co-founder, Technical Director
• GE Healthcare Netherlands (99-05)
• Engineering / General Manager
• Forcare 2006
• Co-founder / Managing Director
• Involvement in IHE since 98
• Representing IHE-Netherlands as
  Vendor-chairsince January 1st, 2006

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What is Integrating the Healthcare Enterprise?

• IHE is a global initiative, providing a common
  framework for passing health information
  seamlessly
• within the healthcare enterprise
• across multiple healthcare enterprises
• for local, regional national health information
  networks.
• IHE is sponsored by healthcare professional
  associations HIMSS, RSNA, ESC, ACC, BIR etc.
• IHE is user-led and vendor-driven
• IHE drives standards adoption to address specific
  clinical needs.

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The IHE Process
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Key IHE deliverables

• Techical Frameworks
• Integration ProfilesA standard way to solve a
  standard problem using standards
• Testing and Demonstrations
• Integration Statements
• Real-world Implementations

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Benefits to IHE Participants

• Care Providers (Clinicians and IT staff)
• Improved workflow
• Information when and where needed
• Decreased cost and complexity of interface
  installation and management
• Vendors
• Decreased cost and complexity of interface
  installation and management
• Accelerate product development
• Expand your market potential by leveraging
  European/ International developments
• Standards-Developing Organizations (SDOs)
• Rapid feedback to adjust standards to real-world
• Establishment of critical mass and widespread
  adoption

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IHE 2006 Eight Active Domains
Over 150 vendors involved world-wide, 8 Technical
Frameworks 55 Integration Profiles, Testing at
yearly Connectathons Demonstrations at major
conferences world-wide
1 Integration Profile
1 Integration Profile
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Overview IHE Domains
Eye Care Eye Care Workflow (EYECARE) Eye
Care Charge Posting (CHG) Eye Care Eye Care
Evidence Documents (ECED)
Cardiology Implantable Device Cardiac
Observations Profile (IDCO) Cardiology Stress
Testing Workflow Integration Profile (STRESS)
Cardiology Patient Demographics Query Urgent
Implantable Device Cardiac Identification
Content Profile (PDQ-IDC) Cardiology Cardiac
Catheterization Workflow (CATH Cardiology Echocard
iography Workflow (ECHO) Cardiology Retrieve ECG
for Display (ECG) Cardiology Displayable Reports
(DRPT) Cardiology Evidence Documents (ED)
Lab Laboratory Scheduled Workflow Lab Sharing
Laboratory Reports (XD-LAB) Lab LOINC Test
Codes Subset (LTCS)
Radiology Scheduled Workflow (SWF) Radiology Patie
nt Information Reconciliation (PIR) Radiology Cons
istent Presentation of Images (CPI) Radiology Pres
entation of Grouped Procedures (PGP) Radiology Acc
ess to Radiology Information (ARI) Radiology Key
Image Note (KIN) Radiology Simple Image and
Numeric Report (SINR) Radiology Charge Posting
(CHG) Radiology Post-Processing Workflow
(PWF) Radiology Reporting Workflow
(RWF) Radiology Evidence Documents
(ED) Radiology Portable Data for Imaging
(PDI) Radiology NM Image (NM) Radiology Cross-ente
rprise Document Sharing for Imaging (XDS-I)
Radiology Teaching File and Clinical Trial
Export (TCE) Radiology Nuclear Medicine Image
Integration Profile (NMI) with Cardiac
Option Radiology Image Fusion (FUS)
Radiology Import Reconciliation Workflow
(IRWF) Radiology Mammography Image (MAMMO)
PC Devices Device Enterprise Communication
(DEC) Rad Oncology RT Objects
PC Coord Cross-Enterprise Sharing of Medical
Summaries (XDS-MS) PC Coord Basic Patient Privacy
Consents (BPPC) PC Coord Emergency Department
Referral (EDR) PC Coord Exchange of Personal
Health Record Content (XPHR) PC
Coord Pre-procedure History and Physical (PPHP)
IT-Infra Retrieve Information for Display
(RID) IT-Infra Enterprise User Authentication
(EUA) IT-Infra Patient Identifier
Cross-referencing (PIX) IT-Infra Patient
Synchronized Applications (PSA) IT-Infra Consisten
t Time (CT) IT-Infra Patient Demographics Query
(PDQ) IT-Infra Audit Trail and Node
Authentication (ATNA) IT-Infra Personnel White
Pages (PWP) IT-Infra Cross-Enterprise Document
Sharing (XDS) IT-Infra Document Digital Signature
(DSG) IT-Infra Notification of Document
Availability (NAV) IT-Infra Patient
Administration Management (PAM)
IT-Infra Cross-enterprise Document Media
Interchange (XDM) IT-Infra Cross-enterprise
Document Reliable Interchange (XDR)
IT-Infra Cross-enterprise Sharing of Scanned
Documents (XDS-SD) IT-Infra Retrieve Form for
Data Capture (RFD) IT-Infra Cross-Enterprise User
Authentication (XUA)
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Back to the overview

• Focus IHE inside the Enterprise Care Setting
• Starting with Radiology
• First IHE domain (1998)
• Wide variety in available systems, but relatively
  streamlined and global process

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Main external Process
Radiology
Acquisition Reporting
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Main Internal process
Radiology Dept Mgt
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IHE Actors / Transactions

• Key terms
• Actor A system performing a particular
  transaction
• Transaction A single interaction between systems
  (actors)
• A system can host multiple actors

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IHE Actors / Transactions
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Radiology Process

• Captured in Scheduled Workflow (SWF) Integration
  Profile
• Backbone of IHE Radiology
• Integrates Registration, Scheduling, Acquisition
  Workflow and Image Content
• Bridges HL7 and DICOM Spaces

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Benefits of Scheduled Workflow

• Preserve Order Continuity / Improve Order
  Tracking
• Close the loop
• Improve Demographic Integrity
• Eliminate manual entry and correction
• Improve Workflow Efficiency
• Worklists
• Reliable Storage
• Storage Commitment
• End result Reduce Integration Effort On site

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So how does this apply...

• to other domains then Radiology?
• The key to understanding IHE is to see the
  process and the data flow
• Taking a few steps back...

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Radiology Process and Data Flow
Data Flow
Registration
Process Flow
Radiology Aquisition Reporting
Evidence Documents
Report Images
Charge Capture
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Reviewing IHE Integration Profiles

• Process View and Data View apply across the
  domains
• The generic process chain shows a great deal of
  overlap for the domains
• IHE promotes the re-use of standards and
  transactions across the domain

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Constructing the Process Chain
Data Flow
Process Flow
Patient Admission
Order Placer
Order Filler
Acquisition
Results Generation
Results Storage
Results Access
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Radiology (1)
Patient Admission
Order Placer
Order Filler
Acquisition
Results Generation
Results Storage
Results Access
Process Flow
Scheduled Workflow (SWF)
Charge Posting (CHG)
Post-Processing Workflow (PWF)
Reporting Workflow (RWF)
Import Reconciliation Workflow (IRWF)
Data Flow
Patient Information Reconciliation (PIR)
Consistent Presentation of Images (CPI)
Presentation of Grouped Procedures (PGP)
Access to Radiology Information (ARI)
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Radiology (2)
Patient Admission
Order Placer
Order Filler
Acquisition
Results Generation
Results Storage
Results Access
Data Flow
Key Image Note (KIN)
Simple Image and Numeric Report (SINR)
Evidence Documents (ED)
Portable Data for Imaging (PDI)
NM Image (NM)
Cross-enterprise Document Sharing for Imaging
(XDS-I)
Teaching File and Clinical Trial Export (TCE)
Image Fusion (FUS)
Mammography Image (MAMMO)
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Cardiology
Patient Admission
Order Placer
Order Filler
Acquisition
Results Generation
Results Storage
Results Access
Process Flow
Cardiac Catheterization Workflow (CATH)
Echocardiography Workflow (ECHO)
Stress Testing Workflow Integration Profile
(STRESS)
Data Flow
Retrieve ECG for Display (ECG)
Evidence Documents (ED)
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Laboratory
Patient Admission
Order Placer
Order Filler
Acquisition
Results Generation
Results Storage
Results Access
Process Flow
Laboratory Scheduled Workflow
Data Flow
Sharing Laboratory Reports (XD-LAB)
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Eye Care
Patient Admission
Order Placer
Order Filler
Acquisition
Results Generation
Results Storage
Results Access
Process Flow
Eye Care Workflow (EYECARE)
Charge Posting (CHG)
Data Flow
Eye Care Evidence Documents (ECED)
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IHE Implementations

• IHE has been in existence since 1998
• IHE Integration Profiles are key building blocks
  for interoperability
• Examples of IHE Implementations can be found at
  www.ihe.net or www.ihe-europe.org
• Success Stories

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Guidance on using IHE

• Practical Guidance on using IHE can be found at
  www.ihe.net
• To apply IHE to Radiology, consult the
• Radiology User Handbook
• To study IHEs approach to workflow, consult the
• Departmental Workflow white paper

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Conclusions

• IHE provides a comprehensive framework for
  addressing interoperability challenges
• IHEs process model promotes re-use across
  domains and stimulates similar solutions to
  similar problems
• IHEs Integration Profiles are showing rapid
  adoption and application across the Enterprise
  Care Settings

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Thank you for your attention
Any Questions?

• IHE Europe web site www.ihe-europe.org